dela Cruz J, et al. A LowCost, Reusable Ultrasound Pericardiocentesis Simulation Model. JETem 2019. 4(4):I17. https://doi.org/10.21980/J8TD1J

ABSTRACT:
Audience: This lowcost, reusable ultrasound pericardiocentesis simulation model is designed to instruct emergency medicine residents and emergency medicinebound students.

Introduction: Cardiac tamponade is a time sensitive, lifethreatening condition that requires prompt intervention. Cardiac tamponade has an incidence of 2 per 10,000 in the U.S. population. Ultrasoundguided pericardiocentesis is a critical treatment for cardiac tamponade that can be safely performed with high success rates. With such a rare likelihood of encountering this condition in clinical practice, deliberate practice is vital for practitioners to be proficient in this lifesaving procedure when the need does occur. Simulation training improves fund of knowledge, comfort in procedures, and performance within simulated scenarios. A key component of simulation training involves utilization of training models that thoughtfully reflect true clinical pictures. The use of clinically realistic models affords residents the opportunity to develop the handeye coordination and cognitive sense needed to perform the procedure safely on real patients, all in a norisk, lowstress setting. Unfortunately, currently available simulation models for training can be expensive and limited in scope.

Educational Objectives: Through the use of this model and skill session, learners will be able to: 1) discuss the indications, contraindications, and complications associated with ultrasound guided pericardiocentesis; 2) demonstrate an ability to obtain subxiphoid and parasternal long views of the heart; 3) demonstrate an ability to identify pericardial fluid in these two views; and 4) demonstrate proper probe and needle placement to successfully perform an ultrasound guided pericardiocentesis in these two views.

Educational Methods: We have developed a reusable, ultrasoundguided pericardiocentesis simulation model that costs approximately $20.00 in materials and takes 10 minutes to construct. The model utilizes a fluidfilled balloon inside a press and seal bag that is covered with pork or beef ribs.

Research Methods: To evaluate the model’s efficacy and learner experience, we created a 5point Likert scale survey to determine whether respondents believed the model was realistic enough to improve their comfort with performing an ultrasoundguided pericardiocentesis. The survey assessed prior experience with the simulation model, whether different models had been used, and individual experience including its utility in representing both subxiphoid and parasternal approaches to the procedure.

Results: From a total of 16 completed surveys, one respondent had performed the procedure clinically, and two had used other simulation models. On a 5point scale, average comfort level to model usage significantly increased 1.38 points from pre to postsimulation. On average, respondents rated the model useful in learning the anatomy and ultrasound image acquisition of the procedure and felt better prepared to perform the procedure postsimulation.

Discussion: Our model provided learners the opportunity to practice ultrasoundguided pericardiocentesis with very little cost or effort to create. Users were able to glean feedback in realtime from the images shown on the ultrasound, as well as from the fluid collected in the syringe. The model differed from others by allowing users to practice in two different views with true anatomical landmarks. Survey results indicate the model was effective in improving learner experience since 87.5% of respondents felt more comfortable with performing the procedure postsimulation. Overall, this model proved useful in offering learners a realistic and costeffective training model for the practice of a rare but important procedure. Emergency medicine residency programs will benefit from the ability to teach and practice ultrasoundguided pericardiocentesis in a controlled environment with immediate opportunities for feedback.